The URL can be used to link to this page

Home My WebLink AboutSTYMANS LT 3Onsite File Stymans Lot 3 #015-272-46 Municipality of Anchorage On-Site Water and Wastewater Program • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191117 PID Number: 015-272-46 Dwelling: ❑ Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New El Upgrade Name: ABSORPTION FIELD McCormick Family Limited Partnership Address ❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound 4101 E. 112th Avenue Anchorage, AK 99516 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot Ft, Ft. Stymans 3 Fill added above original grade Gravel length Township Range Section Ft. Ft. Gravel width Beds: Number of Lines Distance between lines SEPARATION DISTANCES Ft. Ft. To Septic Absorption1L., Holding I Sewer Total absorption area Number of trenches Dist.between trenches Tank Field Lift Station Tank Line From Ft2 Ft. Well >100' ' >100' 1 N/A N/A >25' TANK g Septic El S.T.E.P. ❑ Holding El Other Manufacturer Capacity Surface Water >100' 1 >100' N/A N/A Infiltrator 1094 Gal. Material Number of compartments Lot Line >5' >10' N/A N/APlastic 2 NA Foundation >10' >10' N/A N/A LIFT STATION Manufacturer Capacity I Gal. Curtain Drain I None Noted Remarks Tank replacement only. Pump on level at Pump off level at High water alarm at Tank is insulated. in. in. in. Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank D3034Tank to D3034 Installer drainfield Wilco Contractors Drainfield Existing CO/MT Exist. Inspector J. Williams BENCH MARK (Assumed elevation) 100 ft Inspection 151 5/1/19d Location and description dates: 2" 3,d 4'', Garage slab. COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp_,```\\\ of ALq�1kb Conditional Approval: Date ��,�y •' .c44-16 %* 4g TM • *y ,/ Benja•7 chiller •: j r 9 • CE 12592 •4 i (1t F�sl' 517/19 ....(Z-±e,.vt.C� i Approv-. w.J .._,:`yy� Date�'l0 1� (kk DPROFESSO \\\�� Inspection Report_9-1-12.doc . STYMANS, LOT 3 PERMIT # OSP191117 PID # 015-272-46 112TH AVENUE , - - - - N \ _ / // \ EXISTING WELL \l ..• / 3-BRM HOME // .. :•- EXISTING WELL \\ • ( ( ' ' 0 I NEW 1,000 GALLON SEPTIC TANK / Lot 4 \ . .• •. ••J.. • • • N / Lot 2 , • VACANT\\ ••'•' :• . • . 2cod� \ = i ., 2CO3 �svz \ . N � \\/ - • .• i . SHEo LOT 3 10'UTILITY EASEMENT GE [N61 N[l RIN6 ~,�� A B CO-CLEANOUT j i"� �'q�ll 2COA 42.9 73 2C0-DOUBLE CLEANOUT P. TM 'F9*�I PLAN AS-BUILT 2COB 53.5 82.8 FCO-FOUNDATION CLEANOUT j SV1 53.5 84.1 FS-FLOW SPLITTER VALVE SV2 56.8 87 MH-MANHOLE �/ Benja in Schiller % MT-MONITORING TUBE ,�9F CE in �� 0 50 100 SV-SEPTIC VENT I tsrFq . �•.�.:'79 .• ,`� MI OM FEET TH-TEST HOLE il��'PRorESS1oNs�� 1"=50' STYMANS L3 PERMIT # OSP191117 PID # 015-272-46 O N 0 U (N w (I) N - / 99.6 - - - 2" INSULATION - 96.3 96.1 ,''- 95.3 ^094 GAL 95.4 95.7 INFILTRATOR SEPTIC TANK I'''''--- 91.8 of�4,; `lo j*:49 i '•. %Ta PROFILE AS-BUILT . Benja In Schiller / #1 e CE •t 2592 •'1e'/� iltikGE (NO SCALE) ,ilii.�F0PPOFESSIOlk, eHa,�cepiwo MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite I On -Site Wastewater Disposal System Permit Permit Number: OSP191117 Work Type: SepticTank Upgrade Tax Code Number: 01527246000 Site Legal Address: STYMANS LT 3 G:2635 Site Mailing Address: 4040 E 112TH AVE, Anchorage Owner: MCCORMICK FAMILY LIMITED Design Engineer: FORGE ENGINEERING This permit is for the construction of: Effective Date: Expiration Date Lot Size in Sq Ft: Total Bedrooms: f W r'1Fa:� i[i D('partill ell t' 4/22/2019 4/21/2020 48927 ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. ° 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: N 4 Date: Issued By: Date: 3 SR PFL -- --- — -, PV1UHMPAU7Y OF J NCHO POE Community Development Department `' {� - Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 015-272-46 Property owner(s) McCormick Family Limited Partnership Day phone Mailing address 4101 E. 112th Avenue Anchorage, AK 99516 Site address 4040 E. 112th Avenue Anchorage, AK 99516 Legal description (Sub'd., Block & Lot) Stymans, Lot 3 Legal description (Township, Range & Section) Lot Size 48,927 Sq. Ft. Number of Bedrooms Three (3) APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank ❑X Upgrade ❑X Duplex ElHolding (D) Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: d 31nv Waiver Fees: Date of Payment: L( (22.1 19 Date of Payment: Receipt Number: n I AED Receipt Number: Permit No. ()PIP 11, F-7 Waiver No. Permit App__- ::' ., c PO BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) April 22, 2019 MOA Development Services Dept, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Stymans, Lot 3 – 4040 E. 12th Avenue Septic System Design Dear On-Site Services Engineer: The septic tank on the subject lot is leaking and must be replaced prior to the issuance of a COSA for the property. The attached site plan identifies the location of the home and the existing well and septic system. No conflicts exist between this proposed septic tank and any other well or septic system, whether on this lot or adjacent lots. The new septic tank will be placed a minimum of 5’ from all deck or stairway foundation supports and all lot lines. The existing septic tank will be decommissioned in accordance with Municipal Code. The existing well on the lot is shown. The placement of the new septic tank will not encroach into surrounding protective well radii. Please refer to the attached plan sheet for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Michael E. Anderson, PE 4/22/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191117, Rebecca Carroll, 04/22/19 2CO 10050 0 FEET 1"=50' NOTE: NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE PROPOSED SEPTIC SYSTEM ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC SYSTEMS. CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND STYMANS, LOT 3 4/22/19 112TH AVENUE GRAVELGRAV E L 10' UTILITY EASEMENT SHE D 3-BDRM HOME EXISTING WELL EXISTING SEPTIC TANK. DECOMMISSION PER MOA CODE.NEW 1,000 GALLON SEPTIC TANK CONNECT TO EXISTING SPLITTER BOX EXISTING ABSORPTION SYSTEM TO REMAIN IN SERVICE. 2CO SV SV EXISTING WELL Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191117, Rebecca Carroll, 04/22/19 Municipality of Anchorage Page I of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ~U~' 92, D ~J ~, PID Number: OI3--- ~7~-'-- "~: HS~T~p~ ~T WastewaterSystem: ~New ~Upgrade Address: ~e~O ~ ~ ~ ABSORPTION FIELD Phone: ~ ~__~ IN°'°f~°°ms: ~ Deep Trench ~hallowTrench ~Bed ~Mound ~Other Total Depth from original grade: LEGAL DESCRIPTION sci, Rating: I GPD/Sq. Ft. Lot: Block: Subdivision: Depth to pipe b01t0m from original grade: Gravel depth beneath pipe Town~{*~ IRan~ ¢ ISeoli°n:s{6 *1 Filladded above originalgrade:, Ft. Gravellength: ~O Ft. Upgrade Gravel dcpt~~ Number~of lines:~1Distaacej~between lines: WELL: New Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: Ft. Ft. ~ SQ. Ft. P ~ Driller: Date Drilled: Static Water Level: Installer:~ ~.~ Date installed: Yield:GPM IPump set at: Ft. Icasing Height Ab°ye Gr0uad:Ft. TANK SEPARATION DISTANCES a Septic B Holding ~ S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity i~ ~511ons: From Tank Field Station Tank Sewer Lines Material: Number of Compadments: SurfaCOwater ~ ~ ~ LIFT STATION Lot Size Jn gallons: Manufacturer: Line ~ Cu~ainDrain ~O~ ~ PumpMake&M°del IEIoctricallnspectionspedormedby: * Location and ~ ~ · I ~ ~ Assumed Elevation: Inspections performed by: Dates: 1st ~ ~ ~ ~ ....... 2nd 7: ~ Department of Hea~ and Human Services approval t, ,,,~,, . Reviewed and approved by: _ · ate: / 72-0t3 (1/91) MOA 25 SPLITTfRSDX T~/D TRENCHES 45' LD~G 5' Iv'IDE 7~ £' SAND USE SANJ) ~SZ.-R~K-- TOP 4 FEET SCALD 1' = SO FL N 100 1£S 1.50 0 0 0 TOBBEN SPURKLAND P.E. 203 W 15TH. AVENUE ANCH, AK, 99501 LOT 3 STYMANS SECT10N ~Pl, fl£1g RSW BRENT ~, HJERMSTA.O SEPTIC SYSTEM ASBUILT DATE, AU6.~ 1992 SHEET, 2/3 GRID, 45 _1 5' Wide 45' Long 7' Deep 2' S~nd Filter ,5' Se~er rock 4.5' Cover 10 5 INSTALL CLEAN OUT i000 gal Sep~:ic toni< Monitor Clean Dui: Clean But tPLITTER ~OX NO SCALE 5 TOP OF SPLITTER BOX 1,5 BELOW 6RDUN7 Cleonouts Moni~:or f{~ ~OTfDN DF SAND Miro£1 140 ,5 £t, o£ Sep~clc Rock 2' Filter Sand ND SCALE ~ 87,5 ~DTTDM TESTHDLE DBBEN SPURKLAND P.E, i£03 ~15%h Ave Anchorcge Ak 99501 LUT 3 S?YMANS SEC?IDN 21 T12N R3h/ BRENT M HJE~MSTAD S/D 1000 gal, septic tank TBM GARAGE FLDRR SLAB ASSUMEB ELEVATION 100, OOFT SEPTIC SYSTEM ASDU]LT DATE, AUG, 2~ SHEET, 3/3 GRID, 263.. PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW920248 DESIGN ENGINEER:TOBBEN SPURKLAND, OWNER NAME:HJERMSTAD BRENT M & OWNER ADDRESS:4040 E ll2TH AV ANCHORAGE AK 99516 DATE ISSUED: 8/26/92 P.E. EXPIRATION DATE: 8/26/93 PARCEL ID:01527246 LEGAL DESCRIPTION: STYMANS LT 3 LOT SIZE: 48927 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: ENGINEER MUST VERIFY INTEGRITY OF EXISTING SEPTIC TANK. A TWO FOOT THISK SAND FILTER IS REQUIRED. SW/GW RECEIVING SOILS PERC FASTER THAN 1 M~I. ND/INC~. ISSUED BY: DATE: DATE: 203 W ]5~h, Awnum, Suitm 206 ANCHORAGE, ALASKA 99501 (907) 279-3916 SEPTIC SYSTEM DESiSN LOT g S T Y.~- A D~ S S!Q BRENT H HJERMSTAD i J ....... =::: 1t. 5C:, sq. f .I: .... Exist EieptJ. c: Tanl:: has 5,,5 ~:ee'E o-F c:over SYSTEH .r~ONF-T- E~URAT I ON WIDE TRENCH TOTAL LENGTH ~0 FT. TOTAL WIDTH 5 FT. TOTAL DEPTH 7 FTo SAND FILTER 2 FT. ROCK DEPTH .5 FT. COVER 4.5 FT. SEPTIC TANK EXISTING 1000 GAL. The Jnsta!lat:ic~n o.~ this septic system .~:rom b~'> :i. nstal ]1. el::l or~ the ad.tiacen'l~ ! ]"1'~'~ proposed sept:i.c system ~i:!,], riot cl'~ange the gi,.~nera:t, slope cfi: I'"e!~;ul'(: Yrom ti'ii. ';¢ i r'i%'t:'.al 1 ati c,n,, S(.¥)tJ c: System i])e~;i Lot :]; Stymans S/D I:) g - 2 PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: L~*~"~..,~ 1 13- ~ ~ 14 15- 16- 17- 18- 19- 20- COMMEN~S 5~/~ ~ 1 ' 'EI~GiNEER's SEAL) ~5 DATE PERF~R'~ED: WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT l/ ~,. pO DEPTH? . E Moniloring? [1 /X__, Date: Township, Range, Section: T"! ~.,[',,~ , SLOPE SITE Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER PERFORMED BY: ~ ~ , '~ '~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~ 9; 1 ~ ~ 72-008 (Rev. 4~85) ~ ~ LDT 1 0 0 L~? 22-19 E~AST !~AVE~ v'Lr4 + 0 I ~ LI]T I TOBBEN SPURKLANB P.E. 203 W 15TH. AVENUE ANCH. AK. 99501 IUNflEVELI]PEfl 50 lflfl 15fl 300 SCALE: 1' = lO0 FT. 350 300 SEPTIC SYSTEH BESIGN BATE, AU~, 9, 1992 SHEET~ 1/3 GRII~, 2635 44 EXI$ INSTALL CLEAN DUT TI] SECDND CDMPANTMENT 'TEN BDX N 0 0 0 Z Tk/D TRENCHES 45' LD S' k/IzgE 7' DEEP £' SAND USE SAND F~ ~5 '--/~7K-- 1M TOP 4 FEET SCALE: 1' = SO FT. TD3BEN SPURKLAND P.E, LIlT 3 STYMANS S/B SEPTIC SYSTEM DESIGN PO3 W 15TH. AVENUE ,~ECT]#N £L F/£A~ ~$F DATE, AUE, ~, /~9£ ANCH, AK, 99501 ~NENT M, HJENMSTA,B SHEET, £/$ GRID, ~62,5 4S Nonltor C(ean Cleon Out ~/~de Trenche~'~ 5' ~/lde 45' Long 7' ~eep 2' S~nd FI ,$' Se~er rock 4.5' Cover 10 · Nonltor Cleon Cleon Out 5 INSTALL CLEAN OUT 5 ND SCALE ,5 £t, Miro£1 140 oF Septic Rock 2' FI Item Sand Cleonouts ~. ~ Monitor /--- 4' Topsoil / ~ - Exls~. Ground / _ 1000 gal, septic tank ND SCALE TDBBEN SPURKLAND P,E, 203 ~15th Ave Anchorcge Ak 99501 LOT 3 STYMANS SECTION 21 712N R3~/ 3RENT M HJERMSTAD SEPTIC SYSTEM DESIGN DATE, AU~ ~ 1992 SHEET, 3/3 6RID, 2635 · ~ ~UNICIPALITY OF ANCHORAGE t'~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ~! ENVIRONMENTAL ENGINEERING DIVISION $25 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE ~NEW LEGAL DESCRIPTION Weft ~r Absorption area Dwelling PERMfT NO. = Manufacturer ~ Material S'~L IN°' °f c°mpartments ~ Liq. capacity in gallons Inside lenBth Width ~ Liquid depth ~ ~ O ~ DISTANCE TO: Well Dwelling PERMIT NO. O Z ~ Manufacturer Material Liquid capacity in gallons ~ Well I Foundation ~t Nearest lot line ~ ] PERMITNO, ~ DISTANCE TO: ~OX q ~ ~O~ Distance between lines lengtb o, lir~ X Trench ~t[ No. o, line, Length of eacl~ Total Pl~ ~ I ~ inches ~ Top o¢ tile to finish grade ~ Material beneath tile ~ inches Total effectlv~s~o~n~ I area Length Width Depth PERMIT NO. ~ Type of crib CrJ~ e Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Blass Depth Driller Distance to lot line PERMIT NO. m Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER sol L TEST RATING INSTAELER~ ~1 e~ 72-013 (Rev. 3/781 i:,'F:'F'i Z_.r~ ~F ~'}.FIf<bHHI I !ELL~:-.',LtH E;E;Et~c E. LOCRT ~ Ot',! :L%:'_:-f-H ,';'- TF.IOMF'SON ._E3FL L. '4: :ST'.?FIFaI"4E; :T: "1-' _ST 'E IT_E THE F'E'C THE !_ENGTH DIMENSION IS THE L. Ei'.,iGTH (tN FEET) OF THE TRENCH OR DF::RZNF'.T. EL.D. THE DEPTH OF' R TRENCH OP.'. PIT .'rS THE DiS'T'F!NCE BET!4EEN THE :.:~;LIF..'FRE:E OF THE GF:OUN[:, FIND THE E~O'f"f'OM OF' 'THE ENCFIVRT!ON (]:l'4 FEET). THEIX:E iS:; I'.,IO SET 14IP'rH F,gR TREi'.,ICHES. THE GF:FIVEL DEPTH IS THE i-,iIN!.MLIM [:,EPTH OF: GRR',,,'EL BETI4EEN THE OUTFRLL. F'~PE Fff.~rS, TIdE BOTTOM OF THE EXCFiVRTION (iN F'EET). ,":' ',:' ": ITT "'Il ' ' E:FICk:Fii..L. ING Of;: FIi',!"¢ :.,~_ILM t,,_,r~C,'_q' F'IIqRL DEEF'FIFCI"ME!"4T I,.! ! k.[.. E E SLIB.]'I:EC'i- TO F'F:OSE:L-:L!T i OI"L I',III'.~]:MLIp'I DISTRNCE BE"f'NEEN R I4EL. I,_. FIND FiNY ON,,-,SiTE SENI:IGE DiSF'O::SRI_. SYSTEM IS 'J..60 FEET F'OF: FI F'RIVF!TE !.,.IELL~ O1~'. 'i_6Ei TO ;-?.El0 FEET F,~;'I--I:~ pUBL. IC NELL [:,I:ZF'ENDING UF'ON "!"I--IE; TtCPE OF:' PUBLZC: 14ELI i4ELL, i...O(~¢.:::; F'iRE F.'.EQL!!'I~'.EZ:, I::IND FiLJL:';T' BE P. FZ]'!JP.I',!E[:~ -FO THE C,E]F:'I'qP.'FMENT OF THE NELL COMF:'L..ETZON. Er/"HER REQU]EREI'qENTS HFI*r' FIPPL."rL :~;PEC:iFZE'.RT:[E!i'*IS AND CO}",iSTF'.:UCT]:C,'i"4 DZF~GRFiHS ARE ff,/R ! L. FtBL.E TO I NSL.iI:;.'.E PROPER i i",!:E;"FRLL_iqT I Bfq. BORING NUMBER 't Date Completed: SOIL DESCRIPTION All Samples A SAND Reddish-brown, Dry, Medium Dense Medium to coarse grained SP 2o5I SAND W/SOME GRAVEL, AND TRACE COBBLES Dark Brown to Black, Dry, Medium Dense to Dense Coarse SW 10.5' SAND Brown, Dry to Slightly Moist, Medium Dense to Loose, Medium to Fine Grained SP 20'T.D. NO WATER TABLE ENCOUNTERED LOCATION SKETCH No Scale BRAGAW STi T.H.i~I ~ 100,__u m LOT 3 NOTE: DISTANCES SHOWN ARE APPROXIMATE AND HAVE NOT BEEN MEASURED BY SURVEYING METHODS, EXPLANATION ORGANIC MATERIAL Little Visible Ice 0:10' Vx Ss,72,5Z I°/o~ 85.9 pcf -~---W.D. wAr£~' TABLE BEDROCK TYPICAL SOILS LOG ~ A.a-AFTE~aO~INa SAMPLER TYPE SYMBOLS I ~ O~ANIC ~ ~RAVEL SOIL SYMBOLS I ~0wN' l~~J~ IIIMARSHALL ~LLISON CKD.~'/2'//~ NSULTANTS, INC. BOP~E HOLE ~OG ATE 4 6 78 H ............................ U LOT 3 ~TYMANS SLT~DIVISION L$c~'~e; ;~ov?LL SO'LS LOG J~ aNCUORAG~, AnAsKa GRID. PROJ, NO. 8511 .o. -os MUNICIPALITY OF Development Services Departments On -Site Water & Wastewater Section Parcel I.D. 015-272-46 Certificate of On -Site Systems Approval Legal description STYMANS LT 3 Site address 4040 E 112TH AVE Phone: 907-343-7904 Fax: 907-343-7997 Expiration Date: 7/27/2024 Current property owner(s) MCCORMICK FAMILY LIMITEDPARTNERSHIP XThe On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: By: �� Original Certificate Date: 11/30/23 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval—June 2022 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section t Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 015-272-46 Complete legal description STYMANS LOT 3 Location (site address) 4040 E 112TH AVENUE, ANCHORAGE, AK 99516 Current property owner(s) MCCORMICK FAMILY LTD. PARTNERSHIP... Day phone 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: ® Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ® Plastic ❑ Concrete ❑ Fiberglass Age 4 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ® Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ - _50 Waiver Fee $ _ Date of Payment i I 2 21 17i�0%,� Date of Payment COSA #0 ED C 231 `I .5 2. Waiver # COSA Application.doc COSA Checklist.docx COSA Checklist Legal Description: STYMANS LOT 3 Parcel ID: 015-272-46 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 6/23/1978 Total depth 176 ft Cased to 176 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 18 in. Date of flow test for COSA 11/21/2023 Static water level at beginning of test 137 ft. Well production at time of test 3.4 gpm Water storage tank volume NA gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 2.84 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date 11/17/23 Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank 44” Date of pumping 7/27/2023 Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 8/8/1992 ALL standpipes present per record drawing Total measured depth from grade 7.0 ft (max) Measured depth to pipe invert from grade 4.7 ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes (MT) go to bottom of effective. (ED) If not, state depth into effective Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date 11/21/23 Results Pass West / East Trenches Fluid depth prior to test 0 / 0 in Water added 450 gal New fluid depth 0 / 0 in Elapsed time <5 min Final fluid depth 0 in Absorption rate 450 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 6 in (MOA 0.5’ ED) Effective depth used 0 in (Final Fluid Depth) Effective depth (ED) remaining 6 in Comments/Deficiencies: Approximate total measured depths from existing grade. ED per elevation measured shots & appears approximately that MTs go into sand & ED 1.5’ – 2.2’ below field inverts per shots & MOA record drawings. There are clean outs (CO) at the north ends of each trench and both a CO & MT on the south ends. Below grade flow splitter appears to be functioning. COSA Checklist.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F. ENGINEER’S COMMENTS G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 11/30/2023 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 11/30/23 Rus$ MUNICIPALITY OF ANCHORAGE Development Services Department \ Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On-Site Systems Approval Parcel I.D. 015-272-46 Expiration Date: �--iC 1 [ 1. GENERAL INFORMATION Complete legal description Stymans Lot 3 Location (site address) 4040 E 112th Ave Current property owner(s) JJ McCormick Day phone Mailing address 4101 E 112th Ave, Anchorage, AK 99516 Real estate agent Dan Wolf Day phone (907) 257-0470 2. TYPE OF DWELLING: ,] Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 0 Private Septic x Water Storage ❑ Holding Tank LJ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ 770 Waiver Fee $ Date of Payment SI W O _ Date of Payment Receipt Number Oq5100D Receipt Number COSA# o5Cig il51 Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On-Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering Phone 907-522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage AK 99503 Engineer's Printed Name Benjamin Schiller, P.E. Date 5/6/19 OF At.ikk j*:49TH �'t •*f/ 6. DSD SIGNATURE /• �'� System #1 Approved for bedrooms Benjamin hiller System #2 Approved for bedrooms °fa 9� '• CE 2592 e .• `mo / 'rl�c9 5/6/19 •;_ Amor Disapproved ‘ll -PROFESS10Np�'. . Conditional approval for bedrooms, with the following stipulations: kkik'IN( or AAff,qr // ON-SITE Om WATER AND WASTE\NATER o^ PROGRAM _\-,65\ 0 4 By: t,v., Original Certificate Date: 6-100 .1? The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet COSA Checklist Legal Description: Stymans Lot 3 Parcel ID: 015-272-46 If more than 1 septic system on lot: COSA Checklist# of Structure served by this system A. WELL DATA ❑Well lois filed with Onsite (or attached) Well production at time of test 4.1 gpm Date drilled2.31978 Water storage tank volume NSP` gallons Total depth 1 76 ft Well disinfected for coliform test? ❑ Yes ❑■ No Cased to 176 ft 0 Coliform bacteria is Negative ❑ Sanitary seal is functioning correctly Nitrate 3.03 mg/L ❑ Nitrate less than MRL (ND) I Wires are properly protected Arsenic ug/L 0 Arsenic less than MRL (ND) Casing height(above ground) 18 in. Collected by Forge Engineering Date of flow test for COSA 4/4/19 Date of Sample 3/29/19 Static water level at beginning of test 145 ft Comments B. TANK DATA C. LIFT STATION Age of tank(s) <1 years ❑ Required maintenance completed Tank type/material Septic/ Plastic Age of lift station years Measured operating fluid level in septic tank N/A Lift station material Standpipes/foundation cleanout per record drawing Comments: N/A Date of pumping New Tank D. ABSORPTION FIELD DATA Shallow Trench Which system tested (date installed) 8/8/1992 Adequacy test date 4/4/19 ALL standpipes present per record drawing Results ['Pass For 3 bedrooms Total measured depth from grade 6.9 ft(max) Fluid depth prior to test 0 in Measured depth to pipe invert from grade 4.35 ft(min) Water added 552 gal ❑ N/A— pressurized field New depth 0 in • Monitor tubes go to bottom of effective. If not, state Elapsed time 129 min depth into effective ❑■ Code-required soil cover over field Final fluid depth 0 in ❑ Absorption rate >450 gpd System presoaked (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) No date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: COSA Checklist yellow sheet • • E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout> 100' El Yes if No ft E Yes if No ft Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25' ✓0 Yes if No ft Absorption Field on Lot > 100' 0 Yes if No ft Holding Tank > 100' 0 Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' 0 Yes if No ft 0✓ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0 Yes if No ft —0✓ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No ft Surface Water> 100' 0 Yes if No ft Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' 0 Yes if No ft Private Wells > 100' ✓0 Yes if No ft Water Main > 10' ✓❑ Yes if No ft Community Wells > 200' 0 Yes if No ft Water Service Line > 10' 0 Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' 0 Yes if No ft If absorption field is under driveway comment below Property Line > 10' p Yes if No ft Wells on Adjacent Lots: Water Main > 10' ✓0 Yes if No ft Private Wells > 100' 0 Yes if No ft Water Service Line > 10' 0 Yes if No ft Community Wells > 200' p Yes if No ft Surface Water> 100' 0 Yes if No ft F. ENGINEER'S COMMENTS 4 17\\\\\ G. ENGINEER'S CERTIFICATION OF I4. q1`k I certify that/have determined through field inspections and review r,P•• , ll of Municipal records that the above systems are in conformance with % • NJ.-- * MOA COSA guidelines in effect on this date. *•▪ TM �ilk .• * / Iii; 4 • Benja•7 chiller . �� Fc•.. CE 12592 •��r ,, '�I�'• . 516119 .•�, COSA Checklist yellow sheet lk. 22pROFES$IONa�4 (....'"'l I ® d . N00'08'00"W 296.49 .:, No c. 33 Now--- / F z co IN N) Z S cor 01 gas cID � * 88 o cn < i ?� 67.33 N rn O •3 I SEPTIC . m O Ngo Fl Iv - I N ; ; '' 33' OF`�X N00'08'00"W 296.66 i� ' ALg6, / � • � - 9 / * ., . . - , . * \ , BOBBY F. Bonen / BobbF. Burnett GRAPHIC SCALE: 1 Inch = 40 Feet -6aQ .40 2941 Carriage Drive '7 7 r r Anchorage, Alaska 99507 , BsioNw (907) 350-5541 20 0 20 40 80 \�N.:41.-41" Date Scale Legal Description 5/7/2019 1" = 40' I hereby certify that the property described hereon has been surveyed Lot 3 by me, or at my direction, and that the improvements situated thereon Grid are within the property lines and do not overlap or encroach on the SW 2635 AS-BUILT property lying adjacent thereto unless otherwise shown. That no STYMANS SUBDIVISION improvements on the property lying adjacent thereto encroach on the \....Drawn by Field Book premies in question and that there are no roadways, transmission BFB ASB-2019 PLAT # 74-259 lines or other easements on said property except as shown. Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING '1. Parcel I.D. ORS-. ~7£- ~. GENERAL INFORMATION Complete legal description Location (site ~ddress or directions) Current Property owner(s) Mailing address HAA # ~ q O '?.~C'~'X~'~ Expiration Date: ~ - ,-~ ;;~ -0 /-~ Lending agency Mailing address Day phone Real Estate Agent Day phone Mailing Address Unle~;s otherwise requested, HAA will be held by DSD for pickup. 2. NUMBEROF BEDROOMS: '~ 0 TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class ~ Public Water System Well TYPE OF WASTEWATER DISPOSAL: [~ Individual On-site [~ [] .. Individual Holding tank [] [] Community On-site [] [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one.year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER Name of Firm Address Engineer's Printed Name As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe,.functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. ~ v ,- V'.-t ,,.~.(~ '~~ ~--. Phone' i~-/.~ ~4 Z.o ~' bedrooms. DSD SIGNATURE t-'//''' Approved for Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: (Rev. 01/02) A. WELL' DATA Date coml~iLt~d Totaldepth' I~ fl. Static Water level Well prod'dction WATER SAMPLE RESULTS: Coliform -~colonies/100 mi, Municipality' of Anchorage Development serVices Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage;ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Tank Type/Material '-,~T~,L Tank size {::ilO00' gal. Number of Compartments ~ Foundabon c eanout (Y/N).'*? * Depression Over tank (Y/N) ' Date of'pU;n~ping. ~ . ! . . ~)2~- 200L(' Pumper ABSORPTION FIELD DATA Date installed~:' Soil rating (g.p.d./fl~~ ~ Length.:: ~O' ' ft. Width S ' [ [~,~ fl. Eft. absorption area ~50~ ft~ Monitoring tube Total dep~: Date of adequacy test , ~ - ~- ~ Results (Pass/Fail) Fluid depth in absorption field before test O' Elapsed Time: O min. Finalfluid dept~ O Any rejuvenation treatment (past 12 mo.) (Y/N & type) Parcel ID: el 5-~.?~- WelI.L. og iY/N) Wires properly protected (Y/N) Casing height (above ground) I~' in. AT-INSPECTION ~ (o -3- 2o0,-i ~ - .. g.p.m.',- Other bacteria ~ ~ I~ colonies/100 mi. Collected by: ~;~ Date installed' ~ '~' ~8 Cleanouts (WN) High water alarm (WN) System ty~e ~Ek '~eac~ Gravel below pipe ~ · ~ Dep[ession over field ]~' For.~ bedrooms ., ~' ~ -Newdepth O in. Water added ~0 gal. ~. ~ in. ' Absorption rate >= ~O g.p.d. ~ : If yes. give date Sanitary seal :(Y/N) Y Casedto I'"{-(o ft. - Nitrate [.7~ mg./I. Date of sample: 5T'/~,~/_~ LOT .5 IfA, B, or C provide PWSID # D. LIFT STATION EJ Date installed e in gallons Manhole/Access (Y/N) "Pump on" level at . 'Pump off,, leve in. , High water alar = Datum / Cycles tested ,/~ ' Mee{s alarm & ci~uit requirements? SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: septic taMdliff station on lot Absorption field on lot JOG,5' Public seWer main '.: /V'//~ Sewer/s'eptic Service line ' in. .On adjacent lots )' JOO On adjacent lots ) IoO Public sewer manhole/cleanout ', Holding tank" ' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:" BUilding foundation Water main Wells on adjacent lots , p~:oPerty line)//--Jo 'Water service line SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property 'line zj D .' 'Absorpti0n field Surface water Building foundation ')' ~'O Water main Water Service line Curtain drain, N'/A COMMENTS "Surface water 'Wells 0'n adjacent lots '71~0 ENGINEER'S CERTIFICATION · I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name % ~,i~.~ ~ ~IJ ~' I/,- [~r ~ Date T'~. ~(~! ~ i.I Driveway, parkinglvehiclestorage' '~ ~0 HAA Fee' $ Date of Payment · Receipt Number (Rev. 12/01) c_.iV.. Waiver Fee $ Date of Payment Receipt Number Jun 11 04 ~PantzHildonen Ol .... ._:._ ~ . ~..?....~ . _L~ ~ CE~TiFicAT~N ~ '~[~2~ /..~ 0 - I~p~Pe~nd/~re~r ~e~ated ] ,~,~, ~ ~ ~er~p ~e~r~h ~ aoj~ prope~y and t~atno a : 2x2 hub8 t~k r~ere¢ . , ,~ . e~ms on ~id ~y e~e~ as ~te~ ~erecn. Prepared ~.BUTTON F.B. No. Rd. Reg,"$tered Lon~ Sueveyo~ ProEerty of: . /~ / , /w MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Location (site address or directions) . . 'P"r0perty' 0~n~':'" Cf~ I,! ~-~ ~, Lending agency Mailing address Address tlo /o Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: .~ N TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- . lng to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72~325 (Rev. 1/91) Front MOA~21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Address ~ '5 ~ ~4'-J,~/ Engineer's signature ~ ~ 6. DHHS SIGNATURE .. ,..'" t/~ 'Approved for _,~ ' bedrooms. Disapproved ......... · : . Conditional approval for bedrooms, with the following stipulations: Additional Comments Date ?-/¥ "?2 The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Ancl~orage is not responsible for errors or omissions in the professional engineer's work. 724)25 (Rev. 1/91) Back MOA ~1 Legal Description: Municipality of Anchorage ~ Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST /-.,~-~ ~'~"'ll4"h:~"t//'/..~~ ParcelI.D. ~)/~'" -- ~"'7'~-~' ~'// ~::~ / A. WELL DATA Well type ~ Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. Y ADEC water system number Datecomp,eted Dr,,,er Cased to /"7~:~ Casing height Wires properly protected (Y/N) Date of test Static water level , .. '~ Well flow Pump level FROM WELL LOG AT INSPECTION /b ~ I ~ ~ ENVIRONMENTAL SERVIcEs DIVISION / ~ g.p.m. ~ ~ /~3~ ,~ ] J992 RECEIVED. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ~2 ~ Absorption field on lot J t3_~ ; On adjacent lots )"~ 1 ~ ; On adjacent lots )) ! ¢-,'""~ Public sewer main I~//~ Sewer servic~ line WATER SAMPLE RESULTS: Public sewer manhole/cleanout Petroleum tank N OR '~- Coliform Date of sample: Nitrate lq~)z- Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts (Y/N) y High water alarm (Y/N) Date of pumping Tank size /0--~-~:) Compartments Foundation cleanout (Y/N) ~ Depression (Y/N) I~///..~ Alarm tested (Y/N) Z.- Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~d ~ On adjacent lots To property line c//0 ~ Abso/ption field Surface water/drainage ~'J { ~) Foundation /"//~'-~ ~ Water main/service line ~/) ~ 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION r~///~ Date installed Manufacturer Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Manhole/Access (Y/N) · "Pump off" level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO; Well on lot On adjacent lots ' Surface Water D. ABSORPTION FIELD DATA Date installed_ ~/~-~/~-.- Length ~__(_2 Width '.~ Total absorption area Depression over field (Y/N) Resu t~ (p'ass/fai)! i Soil rating /. Gravel thickness o ~' Cleanouts present (Y/N) Date of adequacy test for Peroxide treatment (past 12 months) (Y/N) }k~L SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~-~)-J~ On adjacent lots ~' [(~ S.ystem type ~'~'~' Total depth If yes, give date PropertY line '~'O bedrooms To building foundation On adjacent lots ~ I ¢ Surface water _. '~ d) VI ~ Curtain drain ~'~ l ID .~¢ ~--' To existing or abandoned system on lot Cutbank ~'~ vi .¢.... , Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and .... HAA guldehnes in effect q~, th8 date of th~s,inspect~on. Signature Engineer's Name .- Date HAA Fee $ ,/~:2'~¢ Date of Payment ~:~ Receipt Number c~-:~ ~,P ~ 72-026 {Rev. 3/01) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date ~ ~'~-/ /~'~ GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) Applicant Name Applicant Address Telephone: Home (b) Business (c) Applicant is (check one): Lending institution []; Owner/builder []; Buyer []; Other [] (explain); (d) Lending Institution Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family [] Multi-Family [] Number of Bedrooms ~ Other WATER SUPPLY Individual Well [] Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite [] Public [] Community [] Holding Ta~ < [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 E~IGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 1 further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Seal DHEP APPROVAL Approved for ")~&"~' ~'g,bedrooms by ~ Approved '_~ Disapproved Terms of Cohditional Approval Gonditiona]. CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) · WELL DATA MUNICIPALITY OF ANCHORAGE {MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: Well Classification Well Log Present (Y/N) Total Depth I ~7~'~ Static Water Level 1 7~ ' Casing Height Above' Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot IfA, B, C, D.E.C. Approved (Y/N) Date Completed ~' / 8~ / 7'8 Yield Cased to _ ~ / 76' ~ Depth of Grouting ~¢/~. Pump Set At ';~ / 71 ~ I ~ o Sanitary Seal on Casing (Y/N) ~' Depression Around Wellhead (Y/N) ,~' ~ C, ¢, ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot I0~ To Nearest Public Sewer Line Cleanout/Manhole N, ~. Water Sample Collected by Water Sample Test Results .~c~ ~ -.~ec ¢0 ; On Adjoining Lots ~ To Nearest Public Sewer To Nearest Sewer Service Line on Lot N, ; Date ,¢~£ ¢-,! Comments B. SEPTIC/HOLDING TANK DATA Date Installed _'7/7'/ Standpipes (Y/N) ~' Air-tight Caps (Y/N) Depression over Tank (Y/N) ~ Pumping/Maintenance ContrAct on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well ~2~ ;~-,-l~/n ¢o To Property Line ~ To Water Main/Service Line Ce ~, Course ~' lO0' Size No. of Compartments Foundation Cleanout (Y/N) Date Last Pumped ,~'/'¢--~¢' ; for N, Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026(fl/84} C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed 7 / ? / 7~ Width of Field ,~o/u Square Feet of Absorption Area ,.~ Depression over Field (Y/N) Results of Last Adequacy Test Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test Separation Distance from Absorption Field: ~3,~''~ .~:~,m To Water-SuppJy Well ~c,~,.~ p.~c To Building Foundation /-'.CH ¢ Lot N¢~ To Water Main/Service Line He/)', To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ,~ 0 0,,~"r~ ( (~'4 ..~o~ ~/¢.~ ¢¢~_¢.¢~-~-.f To Property Line k'~- ~ To Existing or Abandoned System on On Adjoining Lots ~ .~ · To Cutbank (if present) ~,i~ '7 o~ ' D, LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed "~".-'~'"-'"'~-¢'~'¢-- ~ ~ Date '~'/"~./~',~'~ Company ~'~'/;¢'¢',,'~ '~ ~ MOANo. ~"~ Receipt No. _ Date of Payment Amount: $ Page 2 of 2 72 026 (11/84) Engineer's Seal A cho age P.O. 'c~JX 196650 ANCHORAGE, ALASKA 99519-6650 (907) 264-4111 TONY KNOWLES, MA YOR DEPARTMENT OF HEALTH & HUMAN SERVICES September 3, 1986 Theodore F. Moore, P.E. Flattop Technical Services 14530 Echo Street Anchorage, Alaska 99516 Subject: Lot 3 Styman's Subdivision Waiver Request, WR86-125 Dear Mr. Moore: Your request for a waiver of the 100 foot separation distance required between the septic tank and well on the subject lot has been granted. This distance has been waived to 87 feet. This waiver is valid for the existing three bedroom single family dwelling only. Sincerely, Stephen So Morris Civil Engineer On-site Services SSM/ljw THEODORE F. MOORE, P.E. PH: (907) 345-1355 OP TE EHNI:CAL: August 26, 1986 14530 ECHO ST. ANCHORAGE, ALASKA 99516 M.O.A. Dept. of Health and Human Services P.O. Box 6-650 Anchorage, AK 99502 Attn: Steve Morris RE: Well-Septic separation waiver for Lot 3, Styman's S/D Dear Mr. Morris: By means of this letter I am requesting a waiver of the well-septic tank separation distance on Lot 3, Styman's S/D, down from the required 100 feet to 87 feet. Relevent backup information in support of this request is attached. As shown on the As-Built drawing, the system was installed on 7/7/78, and inspected and approved by Frank Allers for the Municipality. The report references a 5' waiver of the well-tank distance (down to 95'). On August 25 of this year I measured a total distance of 90 feet between the well and the septic tank cleanout, so I am requesting a waiver to 87 feet to allow for the clowest projection of the tank. The topography of the lot is generally flat. As shown on the driller's well log, the well was drilled on 6/23/78 to a total depth of 176 feet. The log reports a static water level of 163 feet, however on the day of the test it stood at 170' Steady pumping at 5.0 GPM for the duration of the test produced a drawdown of only one additional foot to 171' The log reports clay between 1 and 45 feet, with numerous other strata reported as mixed gravel and clay. The first water bearing stratum was reported at 159', and the aquifer utilized by the well is at 174 feet. Based on this log, it appears that there is significant vertical separation between the wastewater disposal trench and the aquifer, and that much of this consists of relatively impermeable material. A water sample from the well was tested and showed no contamination by coliform or other bacteria. To test the adequacy of the septic system, I ran a total of 438 gallons of water over a three hour period into the monitor tube at the end of the trench. A 320 gallon surge loading caused the fluid level in the tank to raise 6 inches, but the subsequent absorption rate was 75 gallons per hour, which is more than adequate for a three bedroom system. The low surge capacity may be attributable to the tank not having been adequately pumped in the past, leading to a partial clogging of the gravel. The soils log prepared by R&M on 4/6/78, prior to start of construction of the system, shows different strata of sand extending all the way to a depth of 20 feet. No water table was eacountered at that time, nor was there any evidence of a shallow water table at the time of my test. Based on these factors, it'is my professional opinion that the requested waiver can be granted without compromising public health concerns. Please feel free to call me if you have any questions. Sincerely, Ted Moore, P.E. ~ APPLII ~NT FILLS OUT UPPER HA'~.. i ONLY 7 ~i~ . . ~ L~l.. ~ --~;:, ,'.].' t~/\.,'x.,T.~ ~\~,%L-~ /k. Phone Buyer Lending Institution /\u/~i,\.< ,_,%. (~1~.)[_~ -~*cz ,¢~* Phone C] Public Utility When Connected to Public Utility: [] Holding Tank Inspector Inspector Insp6ctor Inspector ' MUI" ICIPALITY OF r~ ~[ v/ DEPT. OF H~ALTPI R[6EIVED ( } BISAPPROVEB ~ ~ co..~T,O.*.*...ow.' / ~ ~ ';~ '7 ~ Well to Tank ¢ ~ Septic T~k Size /~ DEPARTMENT OF HEALTH & ENVIRONMENTAL ROT O , ,z 825 L Street- A~lchorage. Alaska 99501 ~VI'~(~'~v~ENTAL P~OTE~TJON ENVIRONMENTAL ENGINEERING DIVISION /~U~ ~ 4 1979 Telephone 264-4720 dRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. PROPERTY RESIDENT {If differont from ahovel 2. BUYER MAILING ADDRESS PHONE-- PHONE LEND~ I N/~T U ,~ N MAILING ADDRESS 4. REALTOR/AGENT PHONE PHONE MAILING ADDRESS ,TREE LE'ALDESCR'PT'O"A LOCAT'ON / i TYPE OF RESIDENCE NUMBER OF BEDROOMS ~ One ~ Four SINGLE FAMILY ~ Two ~ Five ~ MULTIPLE FAMILY ~ Three ~ Six [] Other WATERSUP LY 7. ~INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG. A well og s requ red for all wel s drilled since June 1975. For wells drilled prior to that date, gl,v,e well depth (attach log if available.) / '~- , 8. SEWAGE DISPOSAL SYSTEM {~ INDIVIDUAL/ON-SITE~ [] PUBLIC UTI LITY **If individual/on-site, give installation date If system is over two (2) years old an adequacy test'is required by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72~10(3/78) THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS rIME T~ME TIME DATE DATE DATE INSPECTOR I NSP ECTOR I NSPECTO R D]R ECTION8: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX ~ PERMIT NUMBER 2, WATER SUPPLY [] INDIVIDUAL. DEPTH OF WELL [] COMMLJNITY DATE DRILLED [] PUBLIC UTI LITY Connection Varified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []PUBLIC[] INDIVIDUAL/ONuTii_iTY -SITE DATE INSTALLED Connection Verified INSTALLER []SeL~tic Ta'nk or []Holding Tank size:- '['~O If Tank is homemade SOILS RATING give dimensions: ~ ~,~' __ 4, DISTANCESwELL TO: Septic/Holding?.~ ~- Tank Absorption~ ~'~Area Sewer Line Nearest Lot Line Absorption Area to~-earest Lot Line §. COMMENTS [] CONDITIONAL APPROVAL (letter must~ompan¥ eertifieate) [] DISAPPROVED // DATE -- BY (Title) LEGAL DESCRIPTION 72-010 (Rev. 3/78)